HCC Risk Adjustment Quality Auditor

Position:
HCC Risk Adjustment Quality Auditor

Company:
UASI

Location:
Remote

Employment type:
Not specified

Short Summary:
As an HCC Auditor, this individual serves as a key quality and compliance resource by evaluating the accuracy and completeness of CDI staff reviews, validating HCC coding decisions, and ensuring adherence to CMS risk adjustment and organizational standards.

Responsibilities:
- Utilize risk adjustment coding and HCC expertise to perform quality reviews on internal/subcontracted OP CDI staff.
- Use audit tool to analyze quality results and track overall quality.
- Prepare and deliver training on HCC documentation requirements, customized to the client audience (e.g., providers, HCC coders).
- Assess OP CDI chart reviews for missed documentation or query opportunities impacting RAF scores and outcomes.
- Review charts to assure clinical documentation supports MEAT requirements and identify trends in documentation gaps.
- Provide education to staff as needed based on audit findings.
- Identify trends and perform training to improve HCC capture and quality.
- Work with leadership to identify performance needs of OP CDI and create training to increase performance levels.

Requirement:
- 2-5 years of experience in HCC auditing, outpatient CDI, Risk Adjustment, or related healthcare documentation, including responsibility for quality review and compliance oversight.
- Active RN or LPN license required.
- CCDS, CCDS-o, CDIP, CDEO and/or CRC certification strongly preferred.
- Proficiency in Epic workflows, including interpretation and management of OurPractice Advisories/OPAs.
- Strong understanding of ICD-10 coding guidelines, HCC documentation and coding requirements.
- Excellent communication, critical thinking, and organizational skills.
- Comfortable using MS Office, email, VPNs, virtual machines, two-factor authentication, and video conferencing tools (MS Teams, Zoom, etc.).

Benefits:
- Full benefits package, PTO and top pay.
- Collaborative, mission-driven team environment.
- Opportunities for continuous learning, education and professional growth.
- Leadership that values your expertise and input.